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  • Title: [Atypical polypoid adenomyoma of the uterus: a clinicopathological review of 27 cases].
    Author: Bai TJ, Bao DM, Li Y, Wang Y, Cui H, Zhu HL.
    Journal: Zhonghua Fu Chan Ke Za Zhi; 2017 Apr 25; 52(4):244-248. PubMed ID: 28441840.
    Abstract:
    Objective: To investigate the clinical and pathological characteristics of atypical polypoid adenomyoma (APA) for improvement of the diagnosis, different diagnosis and treatment of the disease. Methods: The clinical data, pathological characteristics, and the follow-up information were retrospectively analyzed in 27 cases of APA admitted in Peking Univeristy People's Hospital from 2007 to 2016. Results: The median age was 42.6 years old (range 25-60 years old). Fifteen patients were nullipara, 2 patients were postmenopausal. The most common presenting symptom was abnormal uterine bleeding (81%, 22/27) . Leisions were obtained by using hysteroscopy in 23 cases, hysterectomy 3 cases and dilatation and curettage 1 case. Fertility preserving treatments were performed in 10 patients who had strong desire for fertility, among which 1 case progressed into endometrial carcinoma. Among 15 patients underwent hysterectomy and (or) bilateral salpingo-oophorectomy, 9 cases of them had endometrial atypical hyperplasia. Endometrial carcinoma along with APA were found in three patients, 2 cases of them underwent hysterectomy and bilateral salpingo-oophorectomy and pelvic lymphadenectomy, the other one received medication for fertility preservation. Follow up information were available in 24 cases (89%, 24/27) with a median follow up of 46 months (range 4-108 months), 1 case recurred and 1 case progressed into endometrial carcinoma. One case died of other malignancy, while the other patients were alive. Conclusions: APA is a rare uterine neoplasm mixed with epithelial and mesenchymal component. It occurs mostly in childbearing-age women and its diagnosis is dependent on pathology. Although it's clinical course is benign, there is risk of co-existance of endometrial carcinoma and endometrial atypical hyperplasia. For those who has desire of fertility, the treatment strategy is completely removed the lesion and closely followed up. For those who do not desire to preserve fertility, hysterectomy may be an option. 目的： 分析子宫内膜非典型性息肉样腺肌瘤（APA）的临床及病理特征，并探讨其诊断和治疗方法。 方法： 收集2007—2016年间北京大学人民医院收治的病理诊断为APA的27例患者的临床病理资料，回顾性分析患者的年龄、生育情况、主要临床表现、超声检查和宫腔镜下特征、病理特征、治疗方法及预后等。 结果： 27例APA患者的平均年龄为42.6岁（25~60岁）；15例为未生育患者，2例为绝经后患者；常见的临床症状为不规则阴道流血（22例）；23例宫腔镜手术后、3例子宫全切除术后、1例诊刮术后病理检查诊断为APA，其中3例同时合并子宫内膜样腺癌。27例APA患者中，10例有生育要求患者在宫腔镜下切除病灶后行药物治疗，其中1例药物治疗过程中进展为子宫内膜样腺癌而行手术治疗；14例行子宫全切除±双侧附件切除术，术后发现9例同时存在子宫内膜非典型增生；3例合并子宫内膜样腺癌，其中2例行子宫全切除+双侧附件切除+盆腔淋巴结切除术，1例药物治疗后病理检查证实缓解。术后随访24例（89%，24/27），平均随访时间为46个月（4~108个月），1例复发，1例进展为子宫内膜癌，1例因又患淋巴瘤而死亡，其余患者均存活。 结论： APA多发生于育龄期妇女，确诊依靠病理检查，可同时合并子宫内膜癌或子宫内膜非典型增生；APA的治疗，对于有生育要求的患者可在宫腔镜下行肿物切除术后予药物治疗并严密随诊，对于无生育要求者可行子宫切除术治疗。.
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